Analgesic efficacy of different postoperative analgesia in day-case diagnostic laparoscopy

ABSTRACT

This prospective randomized study was designed to compare the analgesic efficacy of intramuscular non-steroidal anti-inflammatory drug [NSAID], diclofenac sodium, intravenous tramadol and combination of the NSAID and tramadol in 45 ASA grade I and II patients scheduled to undergo day-case laparoscopic diagnosis of infertility. The patients classified into 3 groups each n=15. Group I patients received i.m diclofenac sodium 150 mg. Group II patients received i.v tramadol 1.5 mg/kg. Group III patient receive both drugs. The anaesthetic technique was standardized in all patients and at the end of surgery they received rectus sheath block with local anaesthetic.Patients in group II and III had significantly less postoperative pain in the recovery room, 60 min postoperatively and at discharge from the day-surgery unit and they required rescue analgesia with morphine less often than patient in group I. No difference in either the incidence or severity of nausea and vomiting was observed between the studied groups. The analgesic drugs were well tolerated at the dose given in the study, although dry mouth was significantly more common after administration of tramadol in group I and II. Severe nausea and vomiting was a factor necessitating overnight admission in 2,1 and 1 patients in group I, II and III respectively with no significant difference in the hospital admission rate of the three groups. The time of hospital discharge was less in group III, but no statistically significant difference was found between groups. This study had concluded that the analgesic efficacy of tramadol with rectus sheath blockade is an effective and well tolerated analgesic for day-case laparoscopic surgery than use of NSAID with rectus sheath blockade but combination at NSAID, tramadol and rectus sheath blockade was more effective and better in reducing pain and decreasing the time of hospital discharge with no statistically significant difference was found